A Clinician's Perspective on Anywhere Working and Telehealth

Introduction

The success of anywhere working in telehealth relies on clinicians (practitioners) to successfully utilize their skills in a clinical setting facilitated by technology. The ability to successfully deliver telehealth relies on sufficient technology such as reliable internet as well as competencies and skills to use the technology. Increasingly, information and communication technology (ICT) is used to deliver health services in a variety of health contexts. The success of telehealth adoption relies on clinicians using technology effectively and efficiently to provide health services. However, the curriculum for health practitioners, including physicians and allied health practitioners to date has not included eHealth as a focus in Australian universities (Edirippulige et al., 2018).

Although stakeholders, including universities and accrediting bodies, acknowledge the importance of developing skills in telehealth, the barriers to embedding telehealth into the Australian curriculum is problematic due to competing priorities. Therefore, this lack of focus may contribute to practitioners not having the competencies and skills to utilize technology to deliver telehealth services (Edirippulige et al., 2018).

Access to affordable, reliable technology is a key enabling factor for telehealth. Information and communication technologies (ICT) supporting telehealth service delivery include video conferencing, web-based applications, mobile computing, body sensors and other monitoring applications, in an environment where advances in technology continue to disrupt the way modern healthcare is delivered. Computers are increasingly used for diagnostic tasks that do not necessarily require a visit to a clinician. For example, the Apple ResearchKit platform uses iPhone apps to gather data from patients for medical research into conditions such as autism, epilepsy, and melanoma. The ResearchKit platform remotely transfers medical data such as blood pressure, heart rate and body weight (Kang, 2016).

Smartphone apps provide health data that can inform health practitioners and provide novel opportunities, and new risks, for health care provision (Siddiqui, Miller, McKinley, Maduekwe, & Schwaitzberg, 2014). In The Patient Will See You Now, Topol (2015) argues that the smartphone is the Gutenberg moment (Gutenberg’s printing press enabled the production of books for the masses for the first time in the 1450s) for medicine because medicine is becoming digitized.

New technologies, including big data, automation, and artificial intelligence, are likely to change the health sector, including demand for new skills and capabilities (OECD, 2019). Health apps are capable of both replacing and augmenting tasks undertaken by physicians (general practitioners) such as recording medical history and some diagnoses but cannot perform medical procedures or coordinate a team-based approach (Wattanapisit et al., 2020). In this context, the regulatory framework and protocols on how individuals’ health data can be used and protected are still being developed (Miller, Glisson, Campbell, & Sittig, 2019). Overall, the complexity of telehealth has been underestimated (van Dyke, 2014).

If telehealth is to be sustainable, it must be both effective (clinically appropriate) and efficient concerning service delivery. Thus, in addition to the advancement of new technologies and unresolved issues, it has been challenging to establish the effectiveness and overall cost efficiency of telehealth service delivery because the financial benefits are inconsistent and may be specific to situations, locations or stakeholder groups.

Globally governments are grappling with rising health care costs. The OECD (2019) Health at a Glance report shows that on average OECD countries spend around $US4,000 per person with the USA spending much more than other countries by a significant amount at $US10,000 per person. Australia’s health spending was $US5,006, slightly higher than average. Health expenditure has exceeded economic growth and is predicted to be10.2% of GDP by 2030 across OECD countries, up from 8.8% in 2018. The report shows that in OECD countries, health and social systems employ more workers now than at any other time in history, with about one in every ten jobs found in health or social care.